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immunisation schedule (Ministry of Health 1992; Grant 2000; Grant, pati et al.211l;Turner
2006).
Bronchiectasis has been decreasing in most developed countries but this does not appear to be
the case in New Zealand.In studies that I led, subsequent to the research presented in this
thesis, a prospective investigation was conducted utilising the 'New Zealand paediatric
surveillance Unit', covering 947o of paediatricians nationally. This requested notification and
subsequent data on any new diagnosis of bronchiectasis made in children < 15 years through
2001 and 2002 (Twiss, Metcalfe et al. 2005). The incidence from this study put bronchiectasis
at 3'7/100,000/year, which is seven times greater than the only other comparable national
study done in Finnish children (Sayajakangas, Keistinen et al. 1998). This equates to l/1700
live born children being diagnosed with bronchiectasis before the age of 15 years. If the
incidence rate was to remain static and all these children survived to 15 years of age, this
would equate to a prevalence of 1/3000 children overall. Again a disparity is seen with the
incidence found to be three times higher in Maori children (l/1700) and twelve times higher
in Pacific Island children (1/650) than those with European ethnicity. As well as being
common, the disease was severe as demonstrated in both the Auckland study @dwards, Asher
et al. 2003) and the National study (Twiss, Metcalfe et al. 2005) with g3-93 Vo havingbilateral
disease, and 6l-64%o having three or more of the six lobes of the lung involved. In addition
the incidence of tuberculosis (TB) has decreased for adults in New 7*aland,over the recent
years' but disturbingly there has been no such reduction in paediatric rates as demonstrated by
our review of paediatric TB cases through the 1990s (Howie, Voss et al. 2005). Again
significant ethnic disparities occur in these rates; in children < 15 years, pacific children
account for lTVo of all cases of TB and Maori children for l5vo compared to Europea n at 3Vo.
Unsurprisingly, this condition is also associated with socioeconomic deprivation (Ministry of
Health 2002).
These reports all confirm the extent of paediatric respiratory disease in New Zealand,and the
fact that they do not appear to be on the wane despite the improving statistics seen in other
developed and comparable countries.
1.3
Asthma is one of the most common chronic diseases in the world with an estimated 300
million people affected and the number of disability-adjusted life years lost estimated at
approximately 15 million per year (GINA 2O04; GINA zOO5). Asthma has also had a
demonstrated increase in prevalence in the 1980s and 1990s as evidenced by a number of
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